Elbow Care

Complete Care for Your Elbows

The elbow can be very susceptible to overuse injuries. We see a variety of elbow issues ranging from tendinitis to major ligament tears to cartilage damage. We treat the following injuries and conditions:

Ligament Injuries

The ulnar collateral ligament (UCL) has become known as the Tommy John ligament after Dr. Frank Jobe famously devised an operation for the Dodgers pitcher back in 1974. Prior to that, injury to this ligament typically was the end of a player’s career. Since then, there have been many modifications and improvements that now allow the majority of athletes to return to play. Most of these injuries are due to repetitive loads as opposed to one singular injury. Since injuries to the throwing elbow are on the rise, much more attention is being paid to pitch counts, types of pitches, throwing technique, and the entire human kinetic chain. Rehabilitation following this type of surgical treatment is still very lengthy.

Injury to the lateral ulnar collateral ligament (LUCL) is much less common and more likely to occur from an acute injury such as during wrestling or falling onto an outstretched arm. These often create a symptom of the elbow ‘slipping out’ or pain with an axial load such as pushing up from the arms of a chair. Some of these will improve with a strengthening program but for those that have persistent symptoms there are excellent repair and reconstruction procedures.

Cartilage Injuries

Cartilage can break off in the elbow from an injury or from arthritis and create loose bodies which can cause a loss of motion or locking and catching. One common cause of loose bodies in the elbow is from a condition in late childhood or early adolescence called osteochondritis dissecans (OCD). This is generally a developmental condition but can be exacerbated by repetitive activities such as gymnastics. These conditions can usually be successfully managed with elbow arthroscopy. Severe cases may require a more significant procedure using an osteoarticular graft.

The most common orthopedic repetitive injury to the elbow is called lateral epicondylitis, commonly known as tennis elbow. Tennis elbow is often caused by injury to the muscle in the forearm and typically involves extensor carpi radialis brevis (ECRB) tendon. The ECRB tendon stabilizes the wrist when there is little to no bend in the elbow, such as when a tennis racquet is swung, which gives the common name of tennis elbow. The overuse and repetitiveness of this motion results in microtears in the ECRB tendon near the point that it attaches to the outside bump of the humerus, called the lateral epicondyle. These tears cause pain and inflammation in the elbow.

Symptoms of tennis elbow include pain in the outer elbow especially with firm grip activities.

Depending on the extent of the injury and the patient’s activity level, treatment of the injury can range from non-surgical, which includes rest, anti-inflammatory medications, injections, and physical therapy. In uncommon cases, a small surgical debridement can be performed which is highly successful but can be frustratingly slow. Injection of growth factors (PRP) is also an option for these conditions when the initial remedies fail.

Distal Biceps Tears

These tears occur almost exclusively in males. They usually occur from a sudden load like lifting a heavy object or catching a falling object. Typically, there is a “pop” sensation followed by swelling and bruising over the next few days. The biceps muscle may appear to have migrated upward on the arm. Some patients are surprised that they can still use the arm after a few days, but there is usually a loss of elbow flexion strength as well as even more loss of forearm rotation strength (supination). For active individuals where some loss of strength would be unacceptable, surgical repair is usually recommended and usually allows return to full activity.